冷却射频消融治疗难治性截肢后神经肿瘤相关疼痛：一项前瞻性先导研究。

IF 2.8 4区医学 Q1 REHABILITATION

PM&R Pub Date : 2025-05-30 DOI:10.1002/pmrj.13412

Cole W Cheney, Kyle Mele, Richard Kendall, Colby Hansen, Beau P Sperry, Amanda N Cooper, Taylor Burnham, Aaron Conger, Zachary L McCormick

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引用次数: 0

摘要

背景：神经瘤射频消融（RFA）已成为难治性神经瘤相关截肢后疼痛（PAP）的潜在治疗选择。目的：探讨内冷射频消融（C-RFA）治疗神经肿瘤相关性PAP的可行性。设计：前瞻性单臂先导研究。环境：三级学术医疗中心。参与者：8名神经肿瘤相关PAP患者(平均年龄56.5岁[四分位数间距50.5-68.5]岁；平均体重指数30.2[四分位数间距26.3-34.8]kg/m2)。干预：在2019年至2023年期间招募参与者并接受C-RFA治疗。主要结局指标：采用数字评定量表（NRS）、格罗宁根活动限制量表（GARS）、患者总体印象变化量表（PGIC）和药物量化量表III （MQS-III）评估C-RFA后1、3、6和12个月的疼痛和功能结局。每个结果测量的应答者定义为NRS降低≥50%，GARS改善≥30%，PGIC≥6，MQS-III降低≥6.8点。结果：NRS应答率在1、3、6和12个月分别为25.0% （95% CI, 7.0%-59.1%）、50.0% （95% CI, 21.5%-78.5%）、37.5% （95% CI, 13.7%-69.4%）和50.0% （95% CI, 21.5%-78.5%）。1个月时GARS的应答率为25.0% (95% CI, 7.1%-59.1%)， 3、6和12个月时为12.5% （95% CI, 2.2%-47.1%）。1个月和3个月时PGIC应答者比例为37.5% (95% CI, 13.7%-69.4%)， 6个月和12个月时为12.5% （95% CI, 2.2%-47.1%）。1个月时MQS-III应答率为25.0% (95% CI, 7.1%-59.1%)， 3个月时为12.5% (95% CI, 2.2%-47.1%)， 6个月和12个月时为37.5% （95% CI, 13.7%-69.4%）。C-RFA手术无并发症。结论：这些发现表明神经瘤C-RFA治疗难治性神经瘤相关PAP的可行性，但也表明在更大规模的前瞻性研究中研究这种治疗模式之前，有必要进一步选择患者和优化C-RFA技术。

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Cooled radiofrequency ablation for the treatment of refractory postamputation neuroma-associated pain: A prospective pilot study.

Background: Radiofrequency ablation (RFA) of neuromas has emerged as a potential treatment option for refractory neuroma-associated postamputation pain (PAP).

Objective: To evaluate the feasibility of using internally cooled radiofrequency ablation (C-RFA) for treating neuroma-associated PAP.

Design: Prospective single-arm pilot study.

Setting: Tertiary academic medical center.

Participants: Eight participants with neuroma-associated PAP (mean age 56.5 [interquartile range, 50.5-68.5] years; mean body mass index 30.2 [interquartile range, 26.3-34.8] kg/m²).

Intervention: Participants were recruited and treated with C-RFA between 2019 and 2023.

Main outcome measures: Pain and functional outcomes were assessed at 1, 3, 6, and 12 months after C-RFA using Numeric Rating Scale (NRS), Groningen Activity Restriction Scale (GARS), Patient Global Impression of Change (PGIC), and Medication Quantification Scale III (MQS-III). Responder definitions for each outcome measure were ≥50% NRS reduction, ≥30% GARS improvement, ≥6 on PGIC, and ≥6.8-point MQS-III reduction.

Results: NRS responder rates at 1, 3, 6, and 12 months were 25.0% (95% CI, 7.0%-59.1%), 50.0% (95% CI, 21.5%-78.5%), 37.5% (95% CI, 13.7%-69.4%), and 50.0% (95% CI, 21.5%-78.5%), respectively. Responder rates for GARS were 25.0% (95% CI, 7.1%-59.1%) at 1 month and 12.5% (95% CI, 2.2%-47.1%) at 3, 6, and 12 months. The proportion of PGIC responders was 37.5% (95% CI, 13.7%-69.4%) at 1 and 3 months and 12.5% (95% CI, 2.2%-47.1%) at 6 and 12 months. MQS-III responder rates were 25.0% (95% CI, 7.1%-59.1%) at 1 month, 12.5% (95% CI, 2.2%-47.1%) at 3 months, and 37.5% (95% CI, 13.7%-69.4%) at 6 and 12 months. There were no complications associated with the C-RFA procedure.

Conclusions: These findings indicate the feasibility of neuroma C-RFA as a treatment for refractory neuroma-associated PAP but also suggest that further patient selection and C-RFA technique optimization are warranted before investigating this treatment paradigm in a larger prospective study.

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来源期刊

PM&R REHABILITATION-SPORT SCIENCES

CiteScore

4.30

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.